Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC 27125 | CA |
NPI | 1215169891 |
---|---|
Provider Name | Dr. Sean Michael Mann |
First Address | Park City, UT 84060-7468 |
Second Address | Park City, UT 84060-7468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2009 |
Last Update Date | 17/08/2009 |